Healthcare Provider Details

I. General information

NPI: 1639137383
Provider Name (Legal Business Name): MICHELE V MAHONEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N. CLEVELAND AVENUE SUITE 210
WESTERVILLE OH
43082
US

IV. Provider business mailing address

4335 W. DUBLIN- GRANVILLE RD
DUBLIN OH
43017
US

V. Phone/Fax

Practice location:
  • Phone: 614-889-7772
  • Fax: 614-899-9964
Mailing address:
  • Phone: 614-889-7772
  • Fax: 614-764-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35081127
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35081127
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: